Abstract
BackgroundSimilar to other developing countries, Pakistan is going through a rapid nutrition transition where shift from underweight to overweight and obesity is occurring. In this paper, we report on the relationship of household socioeconomic position (SEP), community SEP and urbanicity with under- and over-weight categories of BMI among Pakistani women.MethodsWe analyzed data on 4,767 women ages 15-49 years enrolled in a nationally representative Pakistan Demographic Health Survey (PDHS) conducted in 2012-13 that employed a multistage, stratified cluster sampling design. We assessed the association of urbanicity, household and community SEP derived from household assets and utilities, with categories of body mass index (BMI) using multinomial regression analysis where normal weight (BMI 18.6-22.5) was the reference category.ResultsThirteen percent of women were underweight (BMI <18.5), 15% pre-overweight (BMI: 22.6-24.9), 25% overweight (BMI: 25.0–29.9) and 14% were obese (BMI≥30). Pre-overweight, overweight and obesity among women increased across household wealth quintiles (HWQs) in a graded fashion whereas there was no significant difference in underweight by household wealth. Women in urban areas were more likely to be obese. There was a pronounced increase in adjusted odds ratios (aORs) for overweight/obesity across HWQs within urban areas compared to rural areas. There was a steeper gradient in aORs for obesity from 1st to 5th HWQs in high income communities compared to the middle- and low income communities. In community-level analyses, communities in urban areas were more likely to have higher levels of obesity while in rural areas, especially in Sindh, more communities were more likely to have a higher level of underweight.ConclusionA shift to higher overweight and obesity than underweight in Pakistan is associated with high household and community wealth as well as living in urban areas. Clustering of obesity and underweight in distinct communities afford opportunity for tailored intervention programs.
Highlights
A shift in the nutritional status from under- to over-weight is happening across developing countries, but trends differ according to economic and dietary shifts within countries and regions[1,2]
We report on the relationship of household socioeconomic position (SEP), community SEP and urbanicity with under- and over-weight categories of body mass index (BMI) among Pakistani women
Pre-overweight, overweight and obesity among women increased across household wealth quintiles (HWQs) in a graded fashion whereas there was no significant difference in underweight by household wealth
Summary
A shift in the nutritional status from under- to over-weight is happening across developing countries, but trends differ according to economic and dietary shifts within countries and regions[1,2]. In Pakistan, the overall proportion of underweight among women has decreased from 25% (1993–94 National Health Survey of Pakistan (NHSP)) to 16% (2011 National Nutrition Survey of Pakistan NNSP)) and 13% (2012–13 Pakistan Demographic and Health Survey (PDHS)) over past two decades[8,9]. There has been an increase in the proportion of overweight (body mass index (BMI): 25) women from 22.5% (1993–94 NHSP) to 34% (2011 NNSP) and 39% (2012–13 PDHS) [8,9]. Regional studies across Pakistan report a trend of increasing overweight and obesity [10,11,12,13]. Similar to other developing countries, Pakistan is going through a rapid nutrition transition where shift from underweight to overweight and obesity is occurring. We report on the relationship of household socioeconomic position (SEP), community SEP and urbanicity with under- and over-weight categories of BMI among Pakistani women
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